Administrative Services Forms

This page last reviewed March 27, 2014

NUMBER FORM TITLE
ARB Hiring Confirmation Letter (Sample Document)
ASD 05 Travel Advance Request
ASD-HRB 14 Employee Check Out/Transfer Form
ASD-HRB 15 Student/Contractor Check Out/Transfer Form
ASD 26 ARB Time Report
ASD 27 ARB Training Request Form
ASD 28 Receipt for Notice to Employee of Rights under FMLA
ASD 33B Request for Personnel Action
ASD 65 Competitive Rating Report Form
ASD 75 Exiting/Transferring ARB Employee Questionnaire
ASD 166 Catastrophic Leave Donation Record
ASD 177 Certification of Understanding of Sexual Harassment
ASD 178 Volunteer Record and Service Agreement
ASD 262A Travel Expense Claim
ASD/SAC/BSS 226 General Supply Order Form - Sacramento
ASD/BMB 227 General Supply Order Form - El Monte
ASD-BMB 290 Employee Acknowledgement Reporting Use of State Vehicles for Commuting
ASD-BMB 292 Form 5 - Business Services Requests
ASD-HRB 86 Training and Development Assignment Plan
ASD-HRB 137 Monthly Report - Use of State Vehicles for Commuting
ASD-HRB 191 Alternate Work Week Schedule Agreement
ASD-HRB 225 Authorization to Release Information
ASD-HRB 246 Reduced Work Time Agreement
ASD-HRB 248 Request for Voluntary Personal Leave Program (VPLP)
ASD-HRB 271 Request for Examination
ASD-HRB 272 Annual Leave Election Form
ASD-HRB 273 Excluded Employee Leave Buy Back Election Request
ASD-HRB 279 Staff Services Analyst (General) Request for Transfer Exam
ASD-HRB 281 Mentee Application
ASD-HRB 288 ARB Mentor/Mentee Evaluation Form
ASD-HRB 291 Ergonomic Assessment Request
ASD-HRB 296 Supplemental Time Off
ASD-OHR 205 Employment Reference Questions
ASD-OHR 220 Job Opportunity Bulletin
ASD-OHR 223 Hire Above Minimum for Extraordinary Qualifications
ASD-OHR 224 Official Personnel File Review Sheet
ASD-OHR 238 Position Justification Form
ASD-MSB 200 Request for Reasonable Accommodation
ASD-MSB 256 Language Services Request
ASD-MSB 284 Bilingual Skills Questionnaire Form
ASD-MSB 289 Incident Report
ASD-PMB 207 First Aid Injury/Illness Report
ASD-PMB 208 Acknowledgement of Receipt of SCIF 3301
ASD-PMB 12 Duty Statement
ASD-TRAIN 302 Career Development Plan
DF-170 Request for Contract, Equipment, Acquisition& Travel Ban
DPA 006 Premium Only Plan (POP) Request for Disenrollment
DPA 012 Special Act/SpecialService Award Recommendation
DPA 025 Affidavit for Economic Dependent Children
DPA 352 FlexElect Reimbursement Claim Form
DPA 680 Affidavit for Domestic Partners Being Claimed as Economic Dependents
DPA 681 Pre-Tax Parking/Third-Party Administrator/Reimbursable Account Claim
DPA 682 Pre-Tax Parking/Third-Party Administrator/Reimbursable Account Enrollment
DPA 689 COBRA Election Form
DPA 690 Verification of Total State Service
EO-OIS Acceptable Internet Use
EO-OIS 01 Request for Employee Technology Services
EO-23 Peer Recommendation for Superior Accomplishment Award Nomination
EO-24 Voluntary Supplemental Performance Evaulation
FORM 700 Statement of Economic Interest
FORM I-9 Employment Eligibility Verification (I-9)
FORM I-129 Petition for a Nonimmigrant Worker Form
FORM W-4 Form W-4 (Personal Withholding & Adjustments)
INF 1101 Authorization for Release of Driver Record Information
PERS CalPERS Retirement Planning Workshop Reservation Form
PERS-BSD 241 Beneficiary Designation Form (CalPERS)
PERS-PRS 221 CalPERS Address Change Authorization Form
PERS-PUB 43 Service Retirement Application
PSD-21 Financial Planning Seminar Registration Form
STD 242 U.S. Savings Bonds Purchase/Deduction Authorization
STD 243 Designation of Persons Authorized to Receive Warrants
STD 261 Authorization to Use Privately Owned Vehicles on State Business
STD 278 Superior Accomplishment Gift or Cash Award Recommendation
STD 436 Duplicate Wage and Tax Statement Request
STD 457 CSU Student Payroll Action Request
STD 610 Health Questionnaire with Physicians Report
STD 618 Benefit Option Selection
STD 618S Industrial Disability Leave with Supplementation Benefits Information & Option Selection Form
STD 619 Industrial Disability Benefits Information
STD 630 Employee Contract Grievance
STD 631 Excluded Employee Grievance
STD 636 Report of Performance for Probationary Employee
STD 637 Individual Development Plan (IDP)
STD 645 Employee Suggestion Form
STD 645A Suggestion Evaluation Report
STD 677 Request for Nondisclosure of Employee Home Address
STD 678 State Application Form
STD 686 Employee Action Request
STD 689 Oath of Allegiance & Declaration of Permission to Work for Persons Employed by State of California
STD 692 Dental Plan Enrollment Authorization
STD 698 Life Insurance Enrollment Authorization
STD 699 Direct Deposit Enrollment Authorization
STD 700 Vision Plan Enrollment Authorization
STD 701C Cash Option Enrollment Authorization - FlexElect Program
STD 701R Reimbursement Account Enrollment Authorization - FlexElect Program
STD 702 Consolidated Benefits Cash Enrollment Election Form
STD 703 Vision Plan Direct Payment Authorization
STD 897 Bilingual Pay Authorization
STD 910 Essential Functions Health Questionnaire
STD 912 Military Service Declaration
Telework Supervisor's Checklist
Telework Safety Home Environment Checklist
Telework Telework Plan


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